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Celebrnttnq A Dnzzltnq Decade!
By Mandy Caid-Jefferson, MS, ROlLO
Education & Training Specialist
Are you ready to celebrate? WIC Services will be hosting the 10th Anniversary of
the Annual Oklahoma NutritionlWlC Conference! The theme for this diamond
anniversary is Celebrating a Dazzling Decade. The conference is scheduled for
February 2-4, 2011, at the Embassy Suites in Norman, Oklahoma.
You are sure to be dazzled by the spectacular lineup of speakers! Zonya Foco will
educate, motivate, and humor nutrition educators with her presentation, How to
Make Nutrition Exciting, Fun & Inspirational. Susan Miller will inspire us to work
in our Positive Zones. Also, you will have the honor of hearing from Oklahoma's
Champion for Nutrition Education, Mayor Mick Cornett. In addition, our long time
friend, Regie Thornton, will be here to help us celebrate this dazzling event!
The conference will kick-off on Wednesday, February 2, 2011 at 11:00 a.m. with
the Laura K. Savage Creativity in Nutrition Education poster setup and nutrition
education sessions. The winner of the poster contest and the winner of the
lesson plan contest will be eligible to attend the 2011 NWA Conference in
Portland, Oregon.
Thursday, Februray 3rd, is a very special day! A Dazzling New Development in
Nutrition Education will be unveiled by Stepahine Pichan and the State WIC staff.
Thursday is also desiginated as Denim and Dia-monds
Day. Be
creative in wearing your denim and lots of
dazzling diamonds!
2 Breastfeeding Business
5 Planned Parenthood
Attends Tulsa Fair
6 Risk Code Changes
7 Vendor News
8 Policy Pointers
9 AAP Policy Update
10 From the Chief/Save the
Date
11 PHOCIS Tips
13 Maximum Benefit Card
13 Independent Clinic
Update
14 Ask Aunt Norma
15 High Five
16 Program Consultant's
Corner
17 WIC Matters
19 Meet the Clinics
29 U~coming Food Package
C anges
Conference and hotel registration can be found online at
www.ok.gov/wic under What's New and Special Meetings. If you have any
questions, please contact Mandy Caid-Jefferson at 1-888-655-2942 or
(405)-271-4676 Extension 50035.
H Oklahoma State
Department of Health
e>reQstf'eediV\9 e>usiness
By Rosanne Smith, ROlLO, IBCLC
Breastfeeding Education Coordinator
WIC's Lactation Support Keeps on Growing!
Congratulations to Angie Johnson, Amy Mauldin, and Carla Robertson for passing the 2010 '
International Board of Lactation Consultant Examiners (IBLCE) exam. They have earned the credential of
International Board Certified Lactation Consultants (IBCLCs). Angie Johnson is a Registered
Dietitian who provides nutrition services in Seminole, Pottawatomie, Hughes and Okfuskee Counties.
Amy Mauldin is a Registered Dietitian and a WIC Program Consultant who provides technical assistance
to WIC clinic staff in 14 counties. Carla Robertson is a WIC Peer Counselor and provides
breastfeeding support to WIC participants in LeFlore County. These three ladies were part of over 4,000
candidates who took the exam across 5 continents, in 40 countries and in 14 languages. They join the
other 20 IBCLCs who are currently employed with OSDH and/or WIC. There are now approximately 120
IBCLCs now serving Oklahoma families.
Amy Mauldin, ROlLO, IBCLC Angie Johnson, ROlLO, IBCLC Carla Robertson, IBCLC
What a great accomplishment ladies! Way to go!
Please note:
The IBLCE exam eligibility requirements are changing in 2012. Here is the link to the new requirements
that will be effective for the 2012 exam:
http://americas.iblce.org/announcing-future-reguirements.
H Oklahoma State
Department of Health
e>reQstf'eedir\9 e>usiness
By Krista Lantz, MS, ROlLO
Relaying the Message
"Breastfeeding and the 1st Month of Life"
Do you ever struggle with how to respond to breastfeeding moms when they ask for formula during the
first month? WIG knows there are situations that are tough: an infant on special formula, a premature
baby, or a mom already supplementing. Per WIG policy, breastfeeding infants may only be issued
supplemental formula after the 1st month of life. This policy was designed to strengthen WIG's
breastfeeding promotion efforts and provide additional incentives to assist mothers in making the
decision to initiate and continue to breastfeed. As breastfeeding advocates, WIG is a model to the
community, hospitals, and businesses. Waiting to issue formula until the first month of life sends a strong
message, "WIG believes in your ability to breastfeed and you GAN breastfeed." Empowering and
building a mother's confidence is vital to her success. With supportive staff and a positive approach,
participants can leave the clinic feeling they have been helped. Even with a strong breastfeeding
message there may be times where supplemental formula is needed during the first month. Making moms
aware of the policy allows them to be prepared to purchase formula in the first month if needed.
A telephone survey was conducted by State WIG staff to learn more about how the policy is perceived
and how WIG can better support the message. Based on the survey, WIG developed five tips for relaying
this message.
1. Get WIC staff on board
• WIG staff needs to support the policy and understand the importance of exclusive
breastfeeding during the first 4-6 weeks while milk supply is being established.
• Staff giving the same response helps avoid conflicting and confusing messages.
2. Relay the message to moms during the first visit and thereafter
• Educate prenatally so moms can be prepared.
• Relay the message to mom at her pregnancy certification appointment and continue to
remind her at other visits. Repetition is the key.
3. Explain the purpose and sell the message
• Emphasize the importance of exclusive breastfeeding in the first month to help protect
the baby and build mom's milk supply.
• Let moms know that we are here to support their breastfeeding efforts and help get
them off to a great start so they can establish a healthy milk supply. .
H Oklahoma State
Department of Health
e>reQstreedir}9 e>usiness continued ...
• Explain that exclusive breastfeeding mothers will receive an enhanced food package
and infants will receive more variety and greater amounts of baby food beginning at 6
months of age.
• Display and show the food package poster. Highlight the larger food packages given to
breastfeeding mothers and infants. Show mom what is in it for her.
4. Focus on the positive
• "It's great you are breastfeeding, good job! I know you are working hard to provide
breastmilk for your baby."
• "We want to support you while you breastfeed. It takes 4-6 weeks for your milk supply
to be fully established. WIC provides formula if needed after the 1st month of your
baby's life."
• "We want to help you reach your breastfeeding goals."
• "WIC has some great new food packages for breastfeeding moms! Let me
tell you more about them today!"
• "WIC has peer counselors, WIC moms just like you, who you can talk to about making
breastfeeding fit into your life."
5. Provide support
• Discuss breastfeeding concerns with mom and make appropriate referrals.
• Refer moms to the Breastfeeding Peer Counselor program, trained breastfeeding
staff, Lactation Consultants, Oklahoma Breastfeeding Hotline 1-887-271-MILK (6455),
and the OSDH breastfeeding website http://bis.health.ok.gov for support and information.
H Oklahoma Stat.
Department of Health
Planned Parenthood of Arkansas and Eastern
Oklahoma Attends Tulsa State Fair
By Planned Parenthood WIC Staff
The sounds of peoplescrearninq and bells ringing are just a few things you experience at the Tulsa State
Fair. For PPAEO WIC, we attended to spread the word about our clinics and to make a few other
resources available to families.
Just a few days post fair, we are all still exchanging stories of our moments there. The first Sunday
brought a man who approached the booth with an ear-to-ear grin studying over the WIC information. Just
then his wife came up in a different kind of mood. After a few glances exchanged between the first time
parents, she informed us that she was pregnant with triplets. The pamphlets and information packets
proved to be much-needed advice and also prompted many questions from how WIC works to tips on
getting junior to eat broccoli and carrots. On Senior Citizen Day, many of the elders came by praising WIC
and stating they participated when their kids were younger and "it was a lifesaver"! Others were also
excited to find out prenatal care is available in the same clinic as WIC. They received information on how
and where to apply for SoonerCare (Title 19). As our days there ended, we all discovered that even though
attending the fair might be costly, the helpful nutrition information from (PPAEO) WIC ... is priceless.
H Oklahoma State
Deportment of Health
Reasons Behind Risk Code Changes
By Nicole Oresback, ROlLO
WIC Program Consultant
After the changes in risk codes took place October 1st, several WIC CPAs have asked why certain risks
were removed, such as pyloric stenosis and consumption of raw or undercooked tofu. The guidance
documents discuss the reasons why new risk criteria were added but do not cover why things were
removed.
Pyloric Stenosis
Pyloric stenosis was removed as a nutrition-related risk condition for infants. Pyloric stenosis is generally
diagnosed soon after birth (usually within the first three weeks of life) and treated immediately with surgery
and a 2-3 day hospital stay. There is no long-term nutrition complication associated with pyloric stenosis
once it is treated, so this condition was removed from the list of allowable nutrition risks. However, a
patient presenting in the WIC clinic with postoperative pyloric stenosis may be assigned Risk 340 for
having undergone recent major surqery.' .
Raw or Undercooked Tofu
Raw or undercooked tofu was deleted from the list of potentially harmful foods based on the revision to the
sixth edition of the American Academy of Pediatrics (AAP) Pediatric Nutrition Handbook." Most tofu
available in supermarkets is pasteurized, commercially sealed, and refrigerated. If the tofu is kept
refrigerated and used within a week after opening and the storage water is changed every day or two after
opening, there is little food safety risk to a healthy person from eating the product raw.2
1 USDA WIC Policy memorandum 98-9, Revision 10 July 31,2009
2 UC Berkeley Wellness Letter, November 1999.
H Oklahoma State
Department of Health
END"······
I! ': '. il '.' , ,. ., .. J; RN,~
By Mark Northcutt
Vendor Management Specialist
Oklahoma Unified
WIC Approved Food Card Update
The Oklahoma State WIC Program is pleased to announce the new updated Oklahoma Unified WIC
Approved Food Card.
Please take time to note the changes that have taken place throughout the folder. New items and sizes
have been added.
Please pay special attention to the shelf stable juice section for the addition of tomato & vegetable juice
in the 46-48 and 640z sizes, as well as the whole grain option section for the addition of new breads.
Minimum stocking requirements have not changed. Also note the new FAQ section in the
fruit & vegetable section.
Remember to dispose of any food cards with the August 2009 date located on the front page
bottom line and replace with these new and improved cards.
If you have any questions, please contact Vendor Management at 405-271-4765 or toll-free at
1-888-655-2942, Extension 14765.
H Oklahoma State
Oepartment of Health
From the Desks of Treta Whitethorn & Persenhone Starks
~poacy Pointers
Welcome Pam!!!
WIC Policy welcomed Pam McKenna onboard November 30, 2010! Pam will be working with the
PHOCISIWIC Helpdesk helping to resolve issues with:
• Unvoiding food instruments
• Issues with transfers
• Assistance with issuing WIC food instruments when it involves:
• Changing the client's status, category, certification date, termination date, and next FI date
• Issues with client records, why a clinic cannot input food packages, or issue Fls, why a clinic cannot
certify or reinstate a participant, and why dates did not change in PHOCIS
You can reach the PHOCISIWIC Helpdesk at (405) 271-4676 Ext. 50046 or 1(888) 655-2942 Ext. 50046
**********************************************************************************************************************
Verifying Proof of Residency
If a participant is receiving Medicaid and you have confirmed enrollment by visiting the
Eligibility Verification System, this site can also be used to confirm proof of residency.
PLEASE NOTE: You will not see the participant's address. You are confirming they are in the
Oklahoma Medicaid/SoonerCare Eligibility Verification System, and are therefore residents of Oklahoma.
If you are a WIC location that would like to have access to the Eligibility Verification System in order to
confirm enrollment and verify proof of residency, please contact Vickie Foster by phone at (405) 271-5585
Ext. 56521 or by email at VickiF@health.ok.gov.
**********************************************************************************************************************
Civil Rights and Security Awareness Trainings
Reminder: Civil Rights and Security Awareness Trainings are to be completed yearly. There is no date
affiliated with the completion of training. As long as the training is completed within a year
of the previous year's training, the requirement has been met.
Civil Rights and Security Awareness Trainings are available online and are accessible by visiting the WIC
Training Link at www.ok.gov/wic. Please be sure to print off a training log to sign and date at the completion
of each training ..
**********************************************************************************************************************
We enjoy answering your questions! Please feel free to email WIC policy related questions
to tretaw@health.ok.gov or persephone@health.ok.gov. The answer to your question may
be selected for publication in an upcoming issue of OkWIC Focus!
This is the section ofOklUC Focus where you can receive fun activities that reveal tips on hall' to continue to improve Oklahoma Wlt:'
and the services you provide each participant. We hope that you find this section helpful in the continued success of your WIC clinic. If
you have any questions regarding WIC Policy fee/Fee to call the policy line at (405) 271-5623 or toll free at J-888-0KLAWJC
(1-888-655-2942).
H Oklahoma State
Department of Health
---~
~ IF(Q)llilcyy mcill CCIlIDrilllcc®1lJRceJP)CO)Ictt
UJP)cill@ltce
By Josie Turner, ROlLO
WIC Program Consultant
American Academy of Pediatrics has recently released a new clinical report
"Diagnosis and Prevention of Iron-Deficiency and Iron-Deficiency Anemia in
Infants and Young Children (0-3 Years of Age)". This clinical report is a
revision of the AAP policy "Iron Fortification of Infant Formulas" from
July 1, 1999. The new report was created to help prevent iron deficiency anemia
in young children including infants who are both breastfeeding and formula fed.
Exclusively Breastfed Infant
The AAP states that full term exclusively breastfed infants have enough iron stores for at least the first four months
of life. Since human milk contains very little iron, it is recommended that exclusively breastfed term infants receive
iron supplementation of 1mg/kg per day starting at four months of age and continued until appropriate
iron-containing complementary foods have been introduced. Complementary foods may include iron-fortified
cereals for infants.
Formula-fed Infant
For formula-fed infants, iron needs for the first 12 months of life can be met by a standard infant formula and the
introduction of iron-containing complementary foods after 4 to 6 months of age, including iron-fortified cereals.
Please note that in some cases, supplements may be necessary if the iron needs are not being met by the intake of
formula and complementary foods.
For infants around six months of age consuming complementary foods, the report recommends at least 11 mg of
iron per day, ideally from iron-rich foods, and then supplementing with liquid iron as needed.
Preterm Infant
Preterm infants should have 2 mg/kg of iron per day for 12 months-an amount equivalent to that found in
iron-fortified formula. Preterm infants receiving only breast milk need this amount as a liquid supplement of 2mg/kg
until they begin eating complementary iron-rich solid foods or are weaned to iron-fortified formula.
Children
The report recommends toddlers 1-3 years of age should have an iron intake of 7mg/day. It is best to get this
amount of iron through eating red meats, cereals fortified with iron, and vegetables that contain iron. Fruits with
vitamin C can help with the absorption of iron. Liquid iron supplements may be given to toddlers from 12-36 months
of age. A chewable multivitamin is suitable for children older than three years.
Encourage mothers to discuss this recommendation with their health care provider in order to decide on appropriate
supplementation. Please refer to the online version of this article at:
http://aappolicy.aappublications. orq/cqilcontentlfull/pediatrics; 126/5/1040.
If there are any questions regarding the above policy changes please refer to the above web link or feel free to call
Josie Turner at 405-271-4676 ext. 50028.
H Oklahoma State
Department of Health
FROM THE CHIEF
Prevention of Obesity: A Vision for Infants
By Terry Bryce
Chief
Let's take a look at a global issue: Obesity. Let's also look at a global strategy: Breastfeeding!
There is no doubt some regions in the world are calling obesity an epidemic. Surgeon General Regina M. Benjamin
stated "today's epidemic of overweight and obesity threatens American's quality and years of healthy life" (The
Surgeon General's Vision for a Healthy and Fit Nation 2010). Until recently, most interventions have focused on
older children. Evidence continues to mount that breastfeeding is a component in the fight against obesity. The
breastfeeding preventative approach may be key in reversing obesity. But wait, if there is a connection, why are
there inconsistent results from studies examining the association between breastfeeding and subsequent obesity?
Unavoidably, various methodological limitations and issues affect this controversial connection.
While breastfeeding for any length of time has health benefits, exclusive breastfeeding appears to have a stronger
protective effect than breastfeeding combined with formula feeding. Additional research is needed to convince some
officials and policy makers that breastfeeding is protective against obesity. But for today, funding and time is limited.
Our vision is for greater breastfeeding duration and thus decreasing the risk of obesity.
Prevention of Obesity: A Vision for Infants
• Breastfeed exclusively for 6 months
• Feed age-appropriate nutritious foods in a responsive manner
• Allow infants to move, stretch, reach, crawl, run, play, and explore throughout their lives
• Allow infants to behave like babies
I am proud our breastfeeding rates are increasing. You are doing a great job and I hope to see even greater
improvement with the recent expansion and emphasis on the Peer Counselor Program. Let's continue to focus on
supporting breastfeeding in the workplace, educating mothers, and increasing professional education.
Thanks again for everything you do to promote and support breastfeeding for the health of Oklahomans!
(J((al ve tIie \f1U\ ate "
OSCJ)J{WIC Service
What's Up With WIC
Annual Oklahoma Nutrition/WIC Conference
What's Up with WIC
Breastfeeding Educator Course
IIth Annual Breastfeeding Symposium
What's Up with WIC
What's Up with WlC
January 7, 2011
February 2-4, 2011
April 8, 2011
April 20-22, 2011
June 3, 20] 1
July 8, 2011
October 14', 20 II
H Oklahoma Stat.
Oepartment of Health
By Priscilla Tiger, ROlLO
WIC Program Consultant
Two of the most common calls that the PHOCISIWIC Help Desk receives are regarding why the cert
date is so far in the future and why on the PHOCIS/Risk Assessment module a certain month will not
open up when the CPA is trying to assign a food package. These issues are somewhat related so I
thought I would use this PHOCIS Tips article to try and explain. This is primarily an issue on women
when they are coming back to the clinic to be recertified postpartum. Let me try to explain this issue to
give you some understanding into why this happens.
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When a woman is certified
as pregnant, her termination
date is automatically set by
PHOCIS to be 6 weeks past
her due date, so in this case
her EDD is 12-29-2010
and her termination date is
2-9-2011. In this example,
Jennifer has been given
food instrument through
1-21-2011. These food
instruments were issued on
10-27-2010.
Jennifer has her baby early on November 30th. She comes back into the clinic on December 2,2010 to be
recertified as a breastfeeding woman. Before she is recertified, you will notice that her term date is still
2-9-11 and her Fl's are printed through 1-21-11. So what is going to happen now to her certification date
and her next FI date when she is recertified? Since she just has food instruments through 1-21-11, her new
certification date will be 1-21-11, not December 2,2010 or February 9,2011. It won't be December 2,2010
because the new certification date takes into consideration how far previous food instruments have been
issued and it won't be February 9, 2011 because she only has food instruments through January 21, 2011.
I know this can be a little confusing, but just remember that we do not want food instruments to overlap and
be printed for the same time frame. PHOCIS will actually show that her visit date was December 2,2011,
but the cert date is in the future. We are currently working to see how we can make this a little less confusing
so hopefully in the future itwill be easier to understand.
H Oklahoma State
Oepartment of Health
So this gets us to the other question-when the CPA gets to the Risk Assessment Module she is unable to
enter a food package for December, why is that month grayed out? It is because the client already has
food instruments dated December 21,2010 through January 21,2011. These food instruments were
issued before she delivered the infant.
How does the CPA know that
she already has food instruments
through January 21,2011? On
the Risk Assessment module
there is a field that says next FI
date. In this case the next FI date
is 1-21-2011.
file: Jro'.odlIes WiCMocUes Gror.Q~ C!f1S!a~
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The CPA wants to give mom the fully breastfeeding package so what should she do? The CPA will need
to explain to the clerk that she wants to have the December Fls reissued for Jennifer. At this point the
clerk is reissuing Fl's from a previous certification and the December food package is entered off of the
Food Instrument Module and not off of Risk Assessment. The CPA still needs to assign the food package
number but the clerk is the one that will actually input the number into the food instrument module.
The actual procedure for issuing food instruments from a previous certification is explained in the Policy
and Procedure Manual, Section C-Food Instruments - Tips on Voiding and Reissuing Food Instruments/
Cash Value Benefits - H. Food instruments/cash value benefits that need a food package change,
and the food instruments are from a previous certification.
You will also notice on children that are being recertified that the certification date is usually not the visit
date. The new certification date is the previous termination date. The child's food instruments will start
on the certification date, not the visit date. For example, a child has a current certification period of
6-29-2010 through 12-29-2010. They come into the clinic on 12-15-10 to be recertified and have been
given food instruments through 12-29-10. The new certification period runs from 12-29-10 through
6-29-2011 and their food instruments begin on 12-29-2010.
I hope this information is helpful. Let me oryour WIC Program Consultant know if you have
additional questions about this information.
H Oklahoma State
Department of Health
Maximum Benefit
Card
By Cheryl Copeland, ROlLO
Relations and Information Specialist
The WIC Maximum Benefit card has been updated
and can now be ordered from shipping and
receiving! Federal Guidelines require that the
choice to achieve the full maximum allowance
must be made available to participants and that
local agencies must provide appropriate
education to participants about how to obtain their
full food package benefit. The Maximum Benefit
card was developed to make providing this
information easier. For more information on when •
to provide the Maximum Benefit card to :• participants, please refer to policy Section A. :
Certification: WIC :
Records and :•
Documentation. :
Please specify ODH :•
868P when :
ordering, and :
• remember to give ••
this valuable tool to :
your participants with: • their WIC Approved :
Food Card so that
, they can receive the
most benefit from
their WIC Food
Instruments!
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••:
COlltl-actOl-'S Corller ••••
• By Richard Woofter Sub-Recipient Contracts Specialist
February is quickly approaching. Again this year, the
Independent Contractor's Meeting is being held in
conjunction with the Statewide WIC Conference. The
date for the Independent Contractors Meeting has been
set for Wednesday, February 2nd and is scheduled from
9am to 11am. Both conferences will be held at the
Embassy Suites in Norman.
In previous years, attendance at the Independent
Contractor's Meeting has been optional; however, that is
not the case this year. Due to language in the
Independent Contract, the contractor's financial officer,
director, or WIC director must attend a mandatory post
award contractor's conference. This is your chance to
meet that contractual requirement.
There will be several items of discussion including review
of the most recently completed and negotiated
contract. As everyone is aware, this is a one-year
contract with four one year renewal periods. Staff from
both WIC Service and other Oklahoma State Department
of Health divisions will be available to answer questions
pertaining to the contract or other areas of concern.
The agenda for the Statewide WIC Conference looks
especially dazzling this year. The lineup of exciting
speakers includes Oklahoma City's own mayor, Mick
Cornett. Hopefully everyone attending the Independent
Contractor's Meeting can make plans to stay for all three
days of the State WIC Conference. Details, as well as the
agenda, can be found on the WIC training link.
Remember, January 15, 2011 is the last date for
registration.
If you have items you would like included on the
Independent Clinic Meeting agenda, please send them to
me at richardw@health.ok.gov. If you have
questions or concerns you can also email those to me, or
call 405-271-4676, Extension 50033. The toll free
number is 1-888-655-2942, Extension 50033.
•••••••
H Oklahoma State
Department of Health
Dear Aunt Norma,
We just had a mom come to our
WIC clinic who insists on buying
Enfamil Premium for her son,
but she wants WIC baby fruits
and vegetables when he turns
six months. What kind of food
package, if any, can I give to him?
Some staff members tell me if we
don't give him formula, we can't
give him anything. He's not a
breastfed baby so I don't feel right
about giving him a breastfeeding
package with higher baby food
amounts. I really don't think it
is right to give a package for a
formula I know isn't going to be
used by this family. What can I
do?
Package Perplexed
Dear Perplexed,
Thank you for asking this timely
question and for wanting to do
whatever you can to help this
family. I am sure you have
already worked with this family
to accept Good Start formula
but that does not sound like it's
an option for them right now.
There is an answer for this
little guy, however. Issue him a
BUY package. What's a BUY
package, you ask? It's a set of
food packages designed just for
this situation. When the caregiver
wants to buy the infant's formula
themselves, FOBUYcan be
entered for the first six months
followed by F6BY1
(for four months) and F6BY2
(for two months)*. These food
packages will generate food
instruments with the phrase, "This
food instrument has no cash
value" on the first food instrument.
Think of this as a placeholder in
case they come back willing to
try Good Start formulas again,
then that food instrument could
be voided and reissued for
formula. The second and third
food instruments have the same
amount of baby foods as the other
fully formula fed infants. Once
you have selected this package
be sure and tell the parents that
as their baby matures, he may
be able to accept Good Start
formula again. They are then
more than welcome to come back
and receive our contract formula.
Thanks for this wonderful
question and hopefully you can
share with your coworkers so no
one is 'perplexed'. Bye for now!
ofWlt c/fo'Una
*Also available:
• Partially BF Infants, age 1-5
months:
o P1BUY
• Partially BF Infants, age 6-11
months:
o P6BY1 (use for 4 months)
and P6BY2
(use for 2 months)
• Occasionally BF Infants, age 1-5
months:
o Y1BUY
• Occasionally BF Infants, age
6-11 months:
o Y6BY1 (use for 4 months)
and Y6BY2
(use for 2 months)
H Oklahoma State
Department of Health
For going ABOVE and BEYOND, WIC Service would
like to bestow high fives on: Rhodena OeWitt ROlLO,
Carrie Emberton ROlLO, Shannon Kennedy MS,
ROlLO and Stacy Walker MA,RO/LO. These nutrition therapists were an integral part of the
continuation of the Individual Nutrition Education pilot project from August 1, 2010-
October 1, 2010. Giving generously of their time, sharing suggestions and keen
observations, they improved the Eating Behavior Assessment Tool for participants and
staff. We would like to thank them for their willingness to pilot this tool and being
instrumental in assisting WIC develop effective nutrition education materials.
If you would like your clinic or someone at your clinic
to be recognized for an outstanding accomplishment,
please email your story to mandyc@health.ok.gov.
Rhodena Dewitt Carrie Emberton
Shannon Kennedy Stacy Walker
H Oklahoma State
Department of Health
w By Christina Windrix, ROlLO
WIC Program Consultant
UPDATE ON INDIVIDUAL NUTRITION
EDUCATION POLICY
The Individual Nutrition Education Policy was revealed at our Annual Oklahoma Nutrition/WIC Conference
in 2010. We are excited to announce that we have completed the final phase in our pilot! The policy will
now go through a few final steps before it is available to ALL our WIC nutritionists for use.
To quickly recap, the new Individual Nutrition Education Policy will allow the high-risk WIC participant to
have access to the expertise and skill of our nutritionists by receiving an Individualized Nutrition Care Plan,
which is required by USDA/FNS. A Nutrition Care Plan will be developed and documented based on the
complete nutrition assessment and planned nutrition counseling and strategies. Tools were developed to
explore the participant's eating behavior and environment. They are available for each participant category
and are titled Eating Behavior Assessment Tools (EBAT). As we all know, the eating environment
influences our nutrition decisions and choices. It has a major impact on nutritional/health status and sets
the stage for a lifetime of eating habits. Guidance sheets have also been developed to assist the local
agency nutritionist understand the objective(s) of each question from the EBAT. The nutrition assessment
includes information obtained through anthropometric measurements, dietary history, nutrition/health goal
set at certification/recertification, and evaluation of the EBAT.
Our pilot took place in both Independent and County Health Departments with six nutritionists assisting in
the pilot, Rhodena DeWitt, Carrie Emberton, Shannon Kennedy, Brenda Sanchez, Lindsay Upchurch, and
Stacy Walker. They provided insightful advice and important feedback to help with the organization of the
EBAT. They reported that the EBAT was helpful for all categories. It provided structure to the Individual
Nutrition Education Appointments and formed a base for nutrition education counseling. After becoming
familiar with the tools, they reported there was enough time to complete all required components of the
individual appointment. Many reported that it made their WIC Encounter documentation easier, especially
if they could not document immediately following the appointment. The tool helped establish a relationship
between the nutritionist and participant. It also helped in forming an open relationship where dialogue can
occur. All of the nutritionists involved in the pilot project reported that they found the tools to be beneficial
in the individual appointment.
As previously mentioned, we are in the final phase of the Individual Nutrition Education Policy. Once this
policy is available, your WIC Program Consultant will contact the local agency nutritionist for further
training.
H Oklahoma State
Oepartment of Health
WIC Matters
Using the New Prenatal Weight
By Cathy Montgomery, MS, ROlLO
WIC Program Consultant
A laminated prenatal weight gain grid has recently been provided to every CPA. Although we no longer
require filing a copy of the prenatal weight gain in the participant record, it is still very important to plot the
pregnant woman's weight. One of the nutrition education protocols for prenatal women is to discuss the
recommended weight gain and rate of gain needed to promote healthy birth outcomes.
The laminated grid is a tool that allows the pregnant woman to see how her weight is progressing and
encourages questions. Plotting the woman's weight on the grid also helps the CPA assess her weight gain
status. Risks 131 and 133 can only be assigned if the weight gain is correctly plotted. Risk 132
(Wt. Loss Current Preg.) is another applicable risk that may e assigned when a pregnant woman is
experiencing low maternal weight gain issues
The new prenatal weight gain grids now have 4 i er nt BMI ranges: Underweight, Normal Weight,
Overweight, and Obese. Here are the steps to follow to correctly use the prenatal weight gain.
Complete the PHOCIS/WIC Health History Module for the pregnant woman. A BMI value will
be assigned based on the height and weight entered.
Using the new Prenatal Weight Gain Grid, find the category that includes the BMI value collected.
o If the BMI is <18.5, use the Underweight recommendations. The Underweight weight
gain range on the graph is a series of blue dots (. ).
o If the BMI is 18.5-24.9, use the Normal weight recommendations. The Normal
weight gain range on the graph is a solid black line ( ).
o If the BMI is 25.0-29.9, use the Overweight recommendations. The Overweight
weight gain range on the graph is a series of green dots and lines L._._._}.
o If the BMI is> or = 30.0, use the Obese recommendations. The Obese weight gain
range on the graph is a series of red lines L ).
H Oklahoma State
Oepartment of Health
WIC Matte rs.;
~e-l're8nanc.y ISMI-Welght (;iain
Rf:rommPllIiatiolllO
Underweight <18.5
2.20{,.61b. ~ain 1" trionester
1·1 ..1.51l.perwesk I,d ano 3"
......... Und.rw.~hl 42
41
1-++++--H-4-H--I-.t40
42
41
40
39
38
37
.,n NormallB.5-24.Y
Vi 2.2-6.6Ibeainl~trionest?r 1l-r-'I"""I"""T""'T"!i"'!"""'I'-"', ~-f+i+-++-+..'i+-+11~ ,~
.~4 lib. per we-ak2rd and 3d ) ~4
.n trenester 1 / 'I.'
s z I5·35Ib. total welsh! gain I+++++++IIH-r+t--M+-I-+-+-+.-.+-M-++-JL-++ 32
31 ! ! 31
30 Overweieht25.0.•zs.s •• 3('
29 I~++++II~I. -'-H+-~~-1~-4A'~~--I142~ 1.1-b.b lb. galll r- trimester ,;
28 0.611>.per ',,,ok 2n'and 3" I+++rl+++1 !+-+I-4I+-I-+-J...-l.'.-+-V+++-I--H 28
27 trin es ter H+-H-++'~·+-4+-I-+-J:.'-I .•--lJ'-H-I+l.L!---.f-+ 27
26 IS·2Slbto.tal weil'ht gain I++t-t-+-++llf+.+~-+-H.-.H-+/fl-+-+-I-++l-."-+-+2E
25 H-l+t-I-++-+'-+++i-+l-++4.-*h. {--+-h-l~+l7::-~ 25
24 Ob ••• ~30.0 .' '7 24
23 1.1-4.4Ib,g.inl"billl€ster 1++++-1-1+.,+.-l+rfH+~'IH--+~'..!..-!~'++ 23 u 0.5 lb.per week 2n'and 3" II I 22
2.1 tritnes.ter L1
LU 1l·20Ib. total wel£llI eoln I ,>.' 1/ I [..I 20
. " ~.in'·' 'fir hne for ' " , I 1/ _, l~ ~~ ~~~~~~~~~~~~I~(~k"~"~~I~I!~~~~I-~t~'~--~~I~ 'Q§...7 I ''P'' tl' C V ill , ,~nI''I''"~.C , 1 / 17
~6 ~J.' d~I~,~mf'44~~~++~~~~'+'+l~~hY~~~'~I--H1€
~~5 , I. '''' 15
'<0'_4 ~i ••~,.\<t¥<I*i' lil~·)f 1..,1 " '" I 14
'::.3 'f'P?t'o :,t'" 11 ~illj ••~>, ..'\1 j,i i .·hIV ~\ 1 ", ~ 12
~2 iih I •• nal\ 'F ihtG.ir· I' 1.[1 'U1-: ","" 1 'I 12
'(ij. 1 (~ssig 1 r "'1"ldel).)' .00 I; I .t··1 :I..' 1 I: r • 11 ::.- • t·1 "" I,~'" ,... ~ ,W
9 +~~+H-+++-+~-H~j,.!P+-I .I.lorl I I I I, J rJ -<:"11 I
-- rl,)nlldl .. 1-++-+-+-44~H-+-~3~
-... O" •.•'e.16hl 1-+++-I-44I--H-h, 'H 31'
I-++++-+-+-+--+-I+--t~ 37
'If
28-40Ib. total weight gain
-----01••••••
o 2 4 6 a 10 12 1£ 16 18 2J 22 24 26 28 3J 32 34 36 38 40
weeks Gestation
Our current protocol pamphlet
MyPyramid for Healthy Eating During
Pregnancy contains the older, outdated
version of the prenatal weight gain grid.
Before providing this pamphlet to the
participant, mark through the outdated
grid. In the future, when this pamphlet
is updated and reprinted, the prenatal
weight grid will be omitted. (Note:
Several CPA staff members have
expressed disappointment in not having
a copy of the weight gain grid to provide
to participants. If you have effectively
utilized this teaching tool in the past, you
are encouraged to make a copy from the
laminated weight gain grid and provide it
to participants who would benefit.)
If you have further questions, your clinic's
WPC will be happy to help.
*Refer to the following for more
educational information:
1) Guidance for WIC Nutrition/Health As-sessment
- Pregnant Woman
(located in the VENA Toolbox-Forms
and Guidance)
2) Growth Assessment Module
(located in the WIC Training Link)
H Oklahoma Stat.
Department of Health
Meet the Clinics
Did you know that there are 88 County Health Department clincis and 38 Independent WIC
clinics in the state of Oklahoma? Do you know where these clinics are located? The next
section of this newsletter is dedicated to our wonderful WICclinics! Wewill be randomly
featuring clincis from across the state in the upcoming editions of OkVVIC Focus. The following
clinics are featured in this edition:
CANADIAN COUNTY HEALTH DEPARTMENTS
Coal County Health Department
NEWMAN MEMORIAL HOSPITAL
ELLIS COUNTY INDEPENDENT CLINIC
HMaskelloCoRunty1H•KealtblNDepartment COMPREHENSIVE HEALTH SERVICES
Neighborhood Services
Organization - Northwest
NEICHBORHOOD SERVICES
ORCANIZATION-WEST
Payne County Health
Department-Cushing
H Oklahoma State
Department of Health
CANADIAN COUNTY
HEALTH DEPARTMENTS
CLINIC INFORMATION:
Canadian County has two sites - Yukon and EI Reno.
WIC is offered daily at both sites by appointments or
walk-ins. Nutrition education classes are offered weekly
and are divided into infant, child, and breastfeeding.
STAFF:
WIC CPAs include: Maria Oeloera, LPN, IBCLC, Kandie McMahill, LPN, and Sue Ellen Majors, LPN.
Other nurses or dietitians help out with recertification appointments when needed. The nurses also make
sure other needs are met during the WIC appointment, such as immunizations.
Lupe Porras, Cecilia Romero and Rose Passmore are available to interpret for Spanish-speaking
participants.
Charlene Hudson, ROlLO, and Jenna Holland, ROlLO, IBCLC do the nutrition education classes and
individual WIC appointments. Charlene has been a WIC dietitian for 11 years and Jenna has worked with
WIC for seven years.
Typically, four clerks help with WIC in Yukon, and three in EI Reno. These helpful clerks make life easier
for the clients by ensuring they get the information and referrals they need, and by getting them quick and
convenient appointments.
CASELOAD:
The WIC case load in September 2010 was 1,798 participants in Yukon and 644 in EI Reno.
• FFY 2010 caseload average of 2,456 participants.
Yukon Clerical:
Janice Arnold, Steve Wheeler,
Jennifer Springer and Helen Aldridge
Yukon Clerical:
Sarah Guthrie and Sherryl Burdick
Yukon Staff
Back Row: Sharon Kibic, Marsha Nichols,
and Judy Wright. Front Row: Maria Deloera,
Donna Novotny, Saundra Main,
Kandie McMahill, and Lora Dysinger
H Oklahoma State
Department of Health
CANADIAN COUNTY HEALTH DEPARTMENTS CONTINUED
Charlene Hudson
EI Reno Staff:
Back: Pat Sneed, Gayle
Black, Cecelia Romero, and
Lupe Porras. Front: Jenna
Holland, Sue Ellen Major,
and Keri McReynolds
ACTIVITIES:
Canadian County Health Department has outstanding support for breastfeeding women and babies.
Canadian CHD administrator, Jay Smith, is very supportive of breastfeeding, and ensures clients have as
much support as possible available to them.
Breastfeeding support at the Canadian County Health Departments includes:
• The entire WIC staff does their part to help moms succeed with breastfeeding.
• Individual appointments are available quickly when there is a breastfeeding issue or
problem .
• Canadian CHD has three lactation consultants on staff.
• The Breastfeeding Peer Counseling Program is available at both sites.
-Sarah Devane ROlLO, IBCLC is the Peer Counselor Coordinator.
-Emily Bruce, Stasha Howard and Keri McReynolds are the Breastfeeding Peer
Counselors - they offer much experience and support to breastfeeding families.
• Breastfeeding Support Groups:
The Breastfeeding Peer Counselor Program coordinates the support groups. Pregnant and
breastfeeding moms on WIC are invited to these support groups and are encouraged to bring a
supportive friend, family member or significant other as well. During the meetings, a topic is
discussed, refreshments are served, a door prize is given out, and there is plenty of.time for
discussions and questions.
• Breastfeeding-friendly Environment:
-Attractive, framed art prints of women breastfeeding are hung in the clinics.
-Private, comfortable places are available at both clinics for moms to breastfeed their
babies.
Breastfeeding
Support:
Stasha Howard,
Sarah Devane and
Keri McReynolds
EI Reno Clerical:
Sharon Vincent,
Dina Kamm,
Pilar Phillips, and
Julie Morlan
Oklahoma State
Department of Health H
Coal County Health
Department
County and Clinic Information:
Organized at 1907 statehood, Coal County, claimed 15,585 residents. In that year Boone Williams of Lehigh, a Democratic
representative to the first state legislature, persuaded the representatives to select Lehigh as the county seat. However, many
individuals objected, and a special election was held in 1908. Citizens selected Coalgate
over Lehigh and Centrahoma. Since more people voted than were registered, Lehigh sued,
but the courts refused to hear the case. Coalgate celebrated its victory with a visit from So-cialist
Party leader, Eugene V. Debs and a barbecue on July 4, 1908. Peter Hanraty, Okla-homa's
chief mine inspector, was Coalgate's first mayor. Coal mining and agriculture have
been the major sources of employment in Coal County; Mining reached its peak between
1910 and 1916 with thousands working daily in the mines.
http://digital.librarv.okstate.edu/encyciopedia/entries/C/C0002.html
Approximately 6,031 people, 2,373 households, and 1,653 families reside in the county.
There is a large Amish community in Clarita of Coal County. Since 1988, the Clarita Amish
have sponsored an annual festival and consignment sale to raise funds to support their
school. At the sale, they feature Amish and Mennonite quilts. This event has grown into a major tourist attraction and a sup-plementary
source of income for the members. It is typically held on the 2nd Saturday in September and is open to the public.
The Coal County Health Department located in Coalgate, Oklahoma originally opened its doors in 1962. In 1993, they opened
their new location. The clinic will perform WIC certifications each day, but Thursday is their main WIC day for both
certifications and nutrition education classes.
Staff:
This Me clinic is typically staffed with one nurse and two clerks. Rhonda Trivitt has been an RN at this site for approximately
15 years. She is planning to retire in December 2010. Currently, they are training Jeanne Davidson to become a floating
nurse between Coal, Ada, Atoka, and Pittsburg counties. During her off time, Jeanne travels with her children to many extra-curricular
activities including dance, baseball, football, and basketball.
The clerical staff includes Mergie Bergman and Debbie Fanning. They
both started at the Coal County Health Department 15 years ago. In
Debbie's spare time, she travels from ballpark to ballpark with her
son. Mergie is engaged in the Coalgate community and is actively
involved in her church. Melody Taylor also assists the clerical staff
when needed. She has been with the Health Department for 12 years.
Cecelia Canales is the local agency nutritionist. She has been with the
Health Department for 26 years. She has three cats. The eldest being
over 18 years old!
Caseload:
The WIC caseload in July 2010 was 199 participants.
FFY 2009 caseload average was 207 participants.
Left to Right: Cecelia Canales, Debbie Fanning,
Jeanne Davidson, Rhonda Trivitt, and
Mergie Bergman
H Oklahoma State
Department of Health
NEWMAN MEMORIAL
HOSPITAL
ELLIS COUNTY INDEPENDENT
CLINIC
CLINIC INFORMATION:
Newman Memorial Hospital in Shattuck is the location of an in-dependent
WIC clinic in Western Oklahoma. Ellis County does
not have a health department; therefore, WIC contracts with
Newman Memorial Hospital to provide WIC services in that
county since June 1995 under the initiation of Gwen Stafford,
RN.
The clinic sees WIC participants every Thursday.
STAFF:
This WIC clinic is typically staffed with one nurse and one clerk. Carolyn Kraft has been the WIC clerk
at this site for 10 years and is planning to retire in December 2010. They are currently
training two new clerks to rotate in the clinic. The newest members of the WIC staff are Lila
Rogers and Melody Lennington. Jean Bartow, RN has been working at this clinic for three and a half
years. Clinic staff works in many other areas of the hospital when not providing WIC services. This
office contracts with Ruth Ann Givens, ROlLO for high risk nutrition education. She visits the clinic
once a month.
CASELOAD:
• The WIC case load in July 2010 was 63 participants.
• FFY 2009 caseload average was 66 participants.
ACTIVITIES:
• Jean helped to implement skin to skin after C-section
deliveries in the hospital after attending WIC breastfeeding
training. The hospital delivers an average of 200 babies a year.
• Ruth Ann teaches a quarterly breastfeeding class to the
community in addition to her WIC classes.
• The hospital is currently being remodeled. The WIC clinic has
moved to another location in the hospital during construction.
Melody Lennington, Carolyn Kraft,
Lila Rogers and Jean Bartow
H Oklahoma State
Department of Health
Haskell County
Health Depqrtment
Clinic InformCltionlCClSeloClq:
Haskell County Health Department is located in the town of Stigler, situated between Lake Kerr and Lake
Eufaula. The average monthly WIC caseload for FFY 2010 was 400 participants.
Martha Speer, Lisa Martin and Sue Davis
StClf(
Bill Pierson, MBA, is the Administrative Director of Haskell County
Health Department. WIC clinic staff include: Sue Davis, Administra-tive
Assistant; Lisa Martin and Martha
Speer, Administrative Technicians; Lisa
Sharp and Angela Proe, Registered
Nurses; Emmy McPeak, Registered
Dietitian and Lactation Consultant and Jenee Hensley, Breastfeeding Peer
Counselor. The staff has a total of 120 years of health department service.
Activities:
Emmy and Jenee host a monthly breastfeeding support group for prenatal and breastfeeding WIC
participants. For the past several years, the health department has hosted a reception to honor
breastfeeding mothers during World Breastfeeding Week. These receptions
include refreshments and door prizes donated by local businesses.
Angela Proe and Lisa Sharp
Haskell County Health Department staff created a farmer's market stand that
won first place at the 2010 local health fair and placed third in the
Laura K. Savage Creativity in Nutrition Education Award this year. Teamwork
is demonstrated by participation in an annual community-wide health fair and
school-based education. We also partner with other local health care
agencies in hosting an annual Back-To-School Round-Up that provides
Jenee Hensley and Emmy & immunizations, school supplies, and haircuts to area school-aged
Jade McPeak children.
H Oklahoma State
Department of Health
e MoR1~N COMPREHENSIVE HEALTH SERVICES
Clinic Information:
Morton Comprehensive Health Services dates back to 1921, when it was opened as Maurice Willows Hospital. In
1941 it was named Morton Memorial Hospital and was renamed Morton Health Center in 1968. Then in 1983, the
center's name was changed to Morton. Morton is a Federally Qualified Health Center (FQHC) and is one of the
largest Community Health Centers in Oklahoma.
In October 2006, Morton moved into a new facility located at 1334 N. Lansing Ave. in Tulsa. In 2008, Morton
became one of only two FQHC facilities in the State of Oklahoma to achieve Joint Commission accreditation
status. In addition to the main facility on Lansing, Morton has three satellite clinics - two in Tulsa and one in
Nowata.
In addition to offering WIC services, Morton also offers other health care services such as optometry, adult &
pediatrics, dental, OB/GYN, behavioral/mental health, laboratory/radiology, pharmacy, HIV testing/counseling,
medical nutrition therapy, DHS outstation and patient/outreach education. Along
with the medical services, Morton also has a transportation department which
assists clients to and from their appointments at the clinic.
Staff:
The WIC department consists of four employees. The staff not only completes
the everyday duties of assisting and processing WIC clients, but also
participates in numerous outreach activities, health fairs, and nutrition
presentation. During the past year, we collaborated with the local food bank
which allowed us the opportunity to offer fresh produce to our WIC clients at
their recert appointments and/or when they came in for nutrition education
classes. The WIC department is open five days a week, Monday thru Friday,
which includes being open until 7:00 pm on Tuesdays. The late Tuesdays
allows WIC participants to take evening breastfeeding and general nutrition
education classes and also gives clients a chance to have evening recertification
appointments.
The WIC department staff strive to create a positive
experience for the WIC participants during their visit to the
clinic. Through the years we have worked to change our
approach for recerts and classes so that the client's
experience is both knowledgeable and fun.
As Oklahoma WIC continues to conquer new horizons, the
WIC department at Morton will surely be there to assist with
the success.
Liz Rangel
Adriana Suazo, CharleneFranklin,and BridgetWalker
H Oklahoma State
Department of Health
Neighborhood Services
Organization - Northwest
Clinic Information:
Neighborhood Services Organization - Northwest WIC Clinic is an independent clinic operating in
Oklahoma County. Neighborhood Services Organization is under the direction of Stacey Ninness,
Executive Director. The clinic provides certifications, nutrition education classes, and individual
nutritionist appointments. Hours of operation are from 7:45 a.m. to 4:15 p.m. Monday through Friday.
Staff:
The staff consists of two clerks, two CWNTs, and one nutritionist. Members of the WIC staff are
Renee Pouncil, Chloe Eyachabbe, Becky Messner, Cutter Milligan, and Suzanne McCoy. The
nutritionist is available three days a week. Job duties of the nutritionist include certifications and
special nutrition education plus individual nutritionist appointments. Special classes for high-risk
populations are Teen Class, Weight Management, Low Iron, and Fit Kids Yoga.
Caseload:
The WIC caseload for November 2010 was 2,102 participants.
Activities:
Renee and Chloe, CWNTs, teach three general classes on Friday and one breastfeeding class.
New general classes are offered every two months. These include: Kick the Junk food Habit Out
the Door and Power Up With Veggies. Breastfeeding classes change quarterly and include The
Early Weeks.
A Blue-Cross-Caring Van Program is offered several times a year. Free vaccinations are provided
for participants.
The WIC staff participates in various health fairs through
the year promoting WIC services & nutrition education.
A successful breastfeeding event was hosted in August
to celebrate World Breastfeeding Week. NSO Northwest
and West WIC Clinics planned a luau luncheon theme
and invited 20 participants who had breastfed
exclusively for three months or more. Games were
played, door prizes and complimentary gifts were given,
and chair massages were provided by the Integrated
Massage Therapy School of Bethany, Oklahoma.
Back Row: Chloe Eyachabbe, Renee Pouncil,
Becky Messner, and Cutter Milligan
Front Row: Suzanne McCoy
H Oklahoma State
Department of Health
NEIGHBORHOOD SERVICES
ORGANIZATION- WEST
NSO West WIC is an independent WIC Clinic located in northwest Oklahoma City. This clinic has been serving a diverse
population of WIC participants for the last 17 years and is open Monday through Friday.
STAi=i= -This WIC clinic is staffed by one Registered Dietitian/lactation Consultant, three CWNTs, and three Clerical staff
under the guidance of the Neighborhood Services Organization Executive Director, Stacey Ninness. Most staff members are
bilingual and all are very customer and service oriented.
Zubaida Begum is the RD/lD, IBClC, overseeing all clinic operations, and has worked at NSO for 14 years. She is fluent
in English, Hindi, and Tamil.
Maria deleon and Karen Villagran are CWNTs. Both began working as WIC Clerks and then trained on the job to
become CWNTs. Maria and Karen each speak Spanish, and have served as CWNTs for the last ten years and five years,
respectively.
Sheila Hystad, who also began as a WIC clerk, completed her training a year ago as a CWNT. She has worked at NSO-West
and NSO-Northwest for five years.
Lilia Enriquez, Magdalena Esparza, and Janine Cox are the clerical staff at this location with a service record of five years,
one and a half years, and three months, respectively. Lilia and Magdalena both speak Spanish. All employees are
full-time staff.
CASE LOAD- This clinic has an average monthly case load of 3,350.
ACTIVITIES-This is a baby friendly clinic, with all staff promoting breastfeeding at every contact. We celebrate World
Breastfeeding Week every year, thanks to the dedication and untiring efforts of the staff plus community support. last year,
staff from both NSO clinics organized a "Hawaiian luau" to honor breastfeeding moms, complete with leis, healthy buffet items,
Polynesian decorations, interactive games, and professional photographs of each participant to take home.
Special and General Nutrition Education classes and Breastfeeding classes (in Spanish and English), are offered weekly.
Several times a year nutrition education classes include food demonstrations and healthy recipe ideas. Individual
appointments are offered daily.
Walk-in recertification appointments are encouraged between
regularly scheduled appointments. IBClC breastfeeding
appointments are also available to resolve breastfeeding
problems without delays and help increase breastfeeding
duration.
This clinic staff has worked hard in the community establishing
positive outreach liaisons. Successful outreach efforts have
taken place with the OKC Public Library System, Head Starts,
elementary school health fairs, and most recently at a health fair
sponsored by OKC Metro Transit.
This summer, staff participated in a pilot project of their own. In
the back alley behind their clinic, on a small strip of land next to
the fence, they grew a garden. They raised okra, bell peppers,
tomatoes, and leafy greens. The produce was shared with all
the staff members who helped tend the garden-plus some fresh
produce left over to share with participants. They wanted to
show you can grow a garden anywhere-and they did!
Back Row: Sheila Hystad, Janine Cox, Maggie Esparza,
Lilia Enriguez, and Karen Villagran. Front Row:
Maria deleon, Zubaida Begum, and Carla Kellogg
Oklahoma State
Oepartment of Health H
Payne County Health
Department -Cushing
Clinic Information:
Payne County has two health department sites. Cushing provides services
for residents in the eastern part of the county. Staff moved into a brand new
facility in May of 2009. Participants are seen for WIC certifications by walk-in
on Monday and Tuesday and by appointment on Wednesday and Thursday.
Nutrition education classes and individual appointments are conducted on
Tuesday and Wednesday.
Staff:
Clerical staff for the clinic are Lori June Focht and Joyce Fox. Lori June
has worked with the health department for over 25 years and Joyce has
worked at the clinic for over 10 years. The clinic's Coordinating Nurse
is Darlene Albrecht, RN. Darlene has worked with the health department
for 11 years. Kay Waggoner, Certified WIC Nutrition Technician, has
been with the health
department for 18
years. Dawn Kukuk,
MS, ROlLO and Sarah
Walker, MS, ROlLO
provide nutrition
services for participants of this clinic. Dawn has worked at the
health department for nine years and Sarah for four years.
Combined, this clinic staff has over 77 years of experience!
Joyce Fox, Kay Waggoner, Darlene Albrecht, and
Lori June Focht
Caseload:
The WIC caseload in September 2010 was 390 participants.
Average monthly WIC caseload for the past year was 397 participants.
Dawn Kukuk and Sarah Walker
Activities:
The Cushing clinic received Honorary Mention as the ERC 2009 County Health Department of the Year.
Staff emphasized their commitment to "teamwork" as a key attribute of their clinic. This attribute was called upon
when the clinic managed a TB outbreak while moving into their new facility and conducting regular clinic services.
H Oklahoma Stata
Department of Health
Upcom.ing Food Package Changes
By Priscilla Tiger
WIC Program Consultant
Nestle has informed us they are making changes in the Gerber Good Start formulas that will happen in
April 2011. Since we issue food instruments three months in advance, we need to make
changes NOW!
What is changing?
Good Start Gentle Plus (powder) is changing from a 12 oz can to a 12.7 oz can.
Good Start Protect Plus (powder) is changing from a 12 oz can to a 12.4 oz can.
- Good Start Gentle Plus 2 (powder) is changing from a 24 oz can to a 22 oz can.
- Good Start Protect Plus 2 (powder) is changing from a 24 oz can to a 22 oz can.
The "Plus" will be removed from the name of all the formulas.
o All new food packages will have the new description on the food instrument.
-Good Start Gentle Plus will become Gerber Good Start Gentle.
-Good Start Protect Plus will become Gerber Good Start Protect.
-Good Start Gentle Plus 2 will become Gerber Good Start 2 Gentle.
-Good Start Protect Plus 2 will become Gerber Good Start 2 Protect.
o Good Start Soy Plus will become Gerber Good Start Soy (description on the FI
will change in March).
o Good Start Soy Plus 2 will become Gerber Good Start 2 Soy (description on the FI will
change in March).
The removal of the word Plus does not mean a change in the product formulation. The products will
remain the same except for the changes in the can sizes.
What is staying the same?
Good Start Soy Plus (powder and concentrate) will be the same size can.
Good Start Soy Plus 2 (powder) will be the same size can
Good Start Gentle Plus (concentrate) will be the same size can.
What does this mean for the clinic staff?
- New food package numbers for the Good Start Gentle Plus, Good Start Protect Plus, Good Start Pro-tect
Plus 2 and Good Start Gentle Plus 2 will be assigned and issued beginning January 3,2011 for
April 2011 and beyond. You will not be able to use the search feature in Risk Assessment until April
2011. You will not be able to assign the new food packages for the months prior to April 2011.
- You will not be able to assign the current food package numbers for Good Start Gentle Plus, Good
Start Protect Plus, Good Start Protect Plus 2 and Good Start Gentle Plus 2 for April 2011 and beyond
beginning on January 3, 2011. You will be able to continue to assign the current food package numbers
for Janua ,Februa ,and March.
H Oklahoma State
Department of Health
Upcoming Food Package Changes continued
The food package numbers will be similar to what they are currently. For example, the Good Start
Gentle Plus full formula package for the 0-3 month infant is FOOOO. The new package will be F0200
and package F6000 will be F6200. For most packages the 3rd digit that is currently a 0 will now be a
2.
The Most Commonly Used Food Package Document and the Abbreviated Food Package List is
being revised and will be available for you to view and print from the WIC Training Link by December
22,2010.
The food packages that have previously been entered for April 2011 through November 2011 for Good
Start Gentle Plus, Good Start Protect Plus, Good Start Gentle Plus 2, and Good Start Protect Plus 2
will be converted to the new numbers by an automated process. This conversion is planned for the
first week of January.
What does this mean for the participant?
Gerber Good Start Gentle will reconstitute to 90 ounces per can. The current Good Start Gentle Plus
reconstitutes to 85 ounces per can. Participants on the full formula package will receive one less can
which will amount to 40 ounces less formula per month. There are some changes in the can amounts
allowed for the partially breastfed and occasionally breastfed infants.
Gerber Good Start Protect will reconstitute to 90 ounces per can. The current Good Start Protect Plus
reconstitutes to 87 ounces per can. Participants on the full formula package will receive one less can
which will amount to 60 ounces less formula per month. There are some changes in the can amounts
for partially breastfed and occasionally breastfed infants.
Gerber Good Start 2 Gentle will reconstitute to 154 ounces per can. The current Good Start Gentle
Plus 2 reconstitutes to 167 ounces per can. Participants on the full formula package will receive the
same amount of cans as they currently receive, but it will amount to 52 ounces less formula per month.
Gerber Good Start 2 Protect will reconstitute to 157 ounces per can. The current Good Start Protect
Plus 2 reconstitutes to 172 ounces per can. Participants on the full formula package will receive the
same amount of cans as they currently receive, but it will amount to 60 ounces less formula per month.
• We are planning to have a handout available that your clinic can print and give to the participant which
will explain the change.
No Egg Packages
We have also created "no-egg" packages for those participants allergic to eggs. There are packages
created for pregnant/partially breastfeeding women, fully breastfeeding women/pregnant with multiples,
nonbreastfeeding/occasionally breastfeeding women, and children. If you need a package with lactose
free milk, acidophilus milk, nonfat dry milk, or evaporated milk please contact the Nutrition Line. Clinic
staff will need to document in the WIC Encounters the participant is allergic to eggs when assigning these
packages. These new food package numbers are available in the revised Most Commonly Used Food
Package Document on the WIC Training Link under Nutrition Education, Food Packages.
If you have questions, please contact your WIC Program Consultant.
H Oklahoma Stata
Department of Health
The State VVICstaff would. uke to thank you for another
great year. VVeappreciate your hard work and dedication to
VVIC!
• • • • • • • • • • • • •
Do you have news or pictures for OkWIC Focus?
Has your clinic had an event that you would like to share with the rest of Oklahoma WIC? Do you know
someone that deserves a High Five? If you have a story, a picture, a nomination for High Five, a question
for Aunt Norma or just have a comment, please contact me at:
Mandy Caid-Jefferson
Education and Training Specialist
2401 NW 23rd Street, Suite 70
Shepherd Mall
Oklahoma City, OK 73107-2475
Phone: (405) 271-4676 Ext. 50035
Fax: (405) 271-5763
Email: mandyc@health.ok.gov
This institution is an equal opportunity provider and employer.
This publication was developed for online distribution by the Oklahoma State Department of Health, as authorized by
Terry L. Cline, PhD, Commissioner of Health. This issue will be available online at www.ok.gov/wic. Copies have been deposited
with the Publications Clearinghouse of the Oklahoma Department of Libraries.
H Oklahoma State
Department of Health

co. o
N s::
L.[)
\.0 CO
LL- >
Celebrnttnq A Dnzzltnq Decade!
By Mandy Caid-Jefferson, MS, ROlLO
Education & Training Specialist
Are you ready to celebrate? WIC Services will be hosting the 10th Anniversary of
the Annual Oklahoma NutritionlWlC Conference! The theme for this diamond
anniversary is Celebrating a Dazzling Decade. The conference is scheduled for
February 2-4, 2011, at the Embassy Suites in Norman, Oklahoma.
You are sure to be dazzled by the spectacular lineup of speakers! Zonya Foco will
educate, motivate, and humor nutrition educators with her presentation, How to
Make Nutrition Exciting, Fun & Inspirational. Susan Miller will inspire us to work
in our Positive Zones. Also, you will have the honor of hearing from Oklahoma's
Champion for Nutrition Education, Mayor Mick Cornett. In addition, our long time
friend, Regie Thornton, will be here to help us celebrate this dazzling event!
The conference will kick-off on Wednesday, February 2, 2011 at 11:00 a.m. with
the Laura K. Savage Creativity in Nutrition Education poster setup and nutrition
education sessions. The winner of the poster contest and the winner of the
lesson plan contest will be eligible to attend the 2011 NWA Conference in
Portland, Oregon.
Thursday, Februray 3rd, is a very special day! A Dazzling New Development in
Nutrition Education will be unveiled by Stepahine Pichan and the State WIC staff.
Thursday is also desiginated as Denim and Dia-monds
Day. Be
creative in wearing your denim and lots of
dazzling diamonds!
2 Breastfeeding Business
5 Planned Parenthood
Attends Tulsa Fair
6 Risk Code Changes
7 Vendor News
8 Policy Pointers
9 AAP Policy Update
10 From the Chief/Save the
Date
11 PHOCIS Tips
13 Maximum Benefit Card
13 Independent Clinic
Update
14 Ask Aunt Norma
15 High Five
16 Program Consultant's
Corner
17 WIC Matters
19 Meet the Clinics
29 U~coming Food Package
C anges
Conference and hotel registration can be found online at
www.ok.gov/wic under What's New and Special Meetings. If you have any
questions, please contact Mandy Caid-Jefferson at 1-888-655-2942 or
(405)-271-4676 Extension 50035.
H Oklahoma State
Department of Health
e>reQstf'eediV\9 e>usiness
By Rosanne Smith, ROlLO, IBCLC
Breastfeeding Education Coordinator
WIC's Lactation Support Keeps on Growing!
Congratulations to Angie Johnson, Amy Mauldin, and Carla Robertson for passing the 2010 '
International Board of Lactation Consultant Examiners (IBLCE) exam. They have earned the credential of
International Board Certified Lactation Consultants (IBCLCs). Angie Johnson is a Registered
Dietitian who provides nutrition services in Seminole, Pottawatomie, Hughes and Okfuskee Counties.
Amy Mauldin is a Registered Dietitian and a WIC Program Consultant who provides technical assistance
to WIC clinic staff in 14 counties. Carla Robertson is a WIC Peer Counselor and provides
breastfeeding support to WIC participants in LeFlore County. These three ladies were part of over 4,000
candidates who took the exam across 5 continents, in 40 countries and in 14 languages. They join the
other 20 IBCLCs who are currently employed with OSDH and/or WIC. There are now approximately 120
IBCLCs now serving Oklahoma families.
Amy Mauldin, ROlLO, IBCLC Angie Johnson, ROlLO, IBCLC Carla Robertson, IBCLC
What a great accomplishment ladies! Way to go!
Please note:
The IBLCE exam eligibility requirements are changing in 2012. Here is the link to the new requirements
that will be effective for the 2012 exam:
http://americas.iblce.org/announcing-future-reguirements.
H Oklahoma State
Department of Health
e>reQstf'eedir\9 e>usiness
By Krista Lantz, MS, ROlLO
Relaying the Message
"Breastfeeding and the 1st Month of Life"
Do you ever struggle with how to respond to breastfeeding moms when they ask for formula during the
first month? WIG knows there are situations that are tough: an infant on special formula, a premature
baby, or a mom already supplementing. Per WIG policy, breastfeeding infants may only be issued
supplemental formula after the 1st month of life. This policy was designed to strengthen WIG's
breastfeeding promotion efforts and provide additional incentives to assist mothers in making the
decision to initiate and continue to breastfeed. As breastfeeding advocates, WIG is a model to the
community, hospitals, and businesses. Waiting to issue formula until the first month of life sends a strong
message, "WIG believes in your ability to breastfeed and you GAN breastfeed." Empowering and
building a mother's confidence is vital to her success. With supportive staff and a positive approach,
participants can leave the clinic feeling they have been helped. Even with a strong breastfeeding
message there may be times where supplemental formula is needed during the first month. Making moms
aware of the policy allows them to be prepared to purchase formula in the first month if needed.
A telephone survey was conducted by State WIG staff to learn more about how the policy is perceived
and how WIG can better support the message. Based on the survey, WIG developed five tips for relaying
this message.
1. Get WIC staff on board
• WIG staff needs to support the policy and understand the importance of exclusive
breastfeeding during the first 4-6 weeks while milk supply is being established.
• Staff giving the same response helps avoid conflicting and confusing messages.
2. Relay the message to moms during the first visit and thereafter
• Educate prenatally so moms can be prepared.
• Relay the message to mom at her pregnancy certification appointment and continue to
remind her at other visits. Repetition is the key.
3. Explain the purpose and sell the message
• Emphasize the importance of exclusive breastfeeding in the first month to help protect
the baby and build mom's milk supply.
• Let moms know that we are here to support their breastfeeding efforts and help get
them off to a great start so they can establish a healthy milk supply. .
H Oklahoma State
Department of Health
e>reQstreedir}9 e>usiness continued ...
• Explain that exclusive breastfeeding mothers will receive an enhanced food package
and infants will receive more variety and greater amounts of baby food beginning at 6
months of age.
• Display and show the food package poster. Highlight the larger food packages given to
breastfeeding mothers and infants. Show mom what is in it for her.
4. Focus on the positive
• "It's great you are breastfeeding, good job! I know you are working hard to provide
breastmilk for your baby."
• "We want to support you while you breastfeed. It takes 4-6 weeks for your milk supply
to be fully established. WIC provides formula if needed after the 1st month of your
baby's life."
• "We want to help you reach your breastfeeding goals."
• "WIC has some great new food packages for breastfeeding moms! Let me
tell you more about them today!"
• "WIC has peer counselors, WIC moms just like you, who you can talk to about making
breastfeeding fit into your life."
5. Provide support
• Discuss breastfeeding concerns with mom and make appropriate referrals.
• Refer moms to the Breastfeeding Peer Counselor program, trained breastfeeding
staff, Lactation Consultants, Oklahoma Breastfeeding Hotline 1-887-271-MILK (6455),
and the OSDH breastfeeding website http://bis.health.ok.gov for support and information.
H Oklahoma Stat.
Department of Health
Planned Parenthood of Arkansas and Eastern
Oklahoma Attends Tulsa State Fair
By Planned Parenthood WIC Staff
The sounds of peoplescrearninq and bells ringing are just a few things you experience at the Tulsa State
Fair. For PPAEO WIC, we attended to spread the word about our clinics and to make a few other
resources available to families.
Just a few days post fair, we are all still exchanging stories of our moments there. The first Sunday
brought a man who approached the booth with an ear-to-ear grin studying over the WIC information. Just
then his wife came up in a different kind of mood. After a few glances exchanged between the first time
parents, she informed us that she was pregnant with triplets. The pamphlets and information packets
proved to be much-needed advice and also prompted many questions from how WIC works to tips on
getting junior to eat broccoli and carrots. On Senior Citizen Day, many of the elders came by praising WIC
and stating they participated when their kids were younger and "it was a lifesaver"! Others were also
excited to find out prenatal care is available in the same clinic as WIC. They received information on how
and where to apply for SoonerCare (Title 19). As our days there ended, we all discovered that even though
attending the fair might be costly, the helpful nutrition information from (PPAEO) WIC ... is priceless.
H Oklahoma State
Deportment of Health
Reasons Behind Risk Code Changes
By Nicole Oresback, ROlLO
WIC Program Consultant
After the changes in risk codes took place October 1st, several WIC CPAs have asked why certain risks
were removed, such as pyloric stenosis and consumption of raw or undercooked tofu. The guidance
documents discuss the reasons why new risk criteria were added but do not cover why things were
removed.
Pyloric Stenosis
Pyloric stenosis was removed as a nutrition-related risk condition for infants. Pyloric stenosis is generally
diagnosed soon after birth (usually within the first three weeks of life) and treated immediately with surgery
and a 2-3 day hospital stay. There is no long-term nutrition complication associated with pyloric stenosis
once it is treated, so this condition was removed from the list of allowable nutrition risks. However, a
patient presenting in the WIC clinic with postoperative pyloric stenosis may be assigned Risk 340 for
having undergone recent major surqery.' .
Raw or Undercooked Tofu
Raw or undercooked tofu was deleted from the list of potentially harmful foods based on the revision to the
sixth edition of the American Academy of Pediatrics (AAP) Pediatric Nutrition Handbook." Most tofu
available in supermarkets is pasteurized, commercially sealed, and refrigerated. If the tofu is kept
refrigerated and used within a week after opening and the storage water is changed every day or two after
opening, there is little food safety risk to a healthy person from eating the product raw.2
1 USDA WIC Policy memorandum 98-9, Revision 10 July 31,2009
2 UC Berkeley Wellness Letter, November 1999.
H Oklahoma State
Department of Health
END"······
I! ': '. il '.' , ,. ., .. J; RN,~
By Mark Northcutt
Vendor Management Specialist
Oklahoma Unified
WIC Approved Food Card Update
The Oklahoma State WIC Program is pleased to announce the new updated Oklahoma Unified WIC
Approved Food Card.
Please take time to note the changes that have taken place throughout the folder. New items and sizes
have been added.
Please pay special attention to the shelf stable juice section for the addition of tomato & vegetable juice
in the 46-48 and 640z sizes, as well as the whole grain option section for the addition of new breads.
Minimum stocking requirements have not changed. Also note the new FAQ section in the
fruit & vegetable section.
Remember to dispose of any food cards with the August 2009 date located on the front page
bottom line and replace with these new and improved cards.
If you have any questions, please contact Vendor Management at 405-271-4765 or toll-free at
1-888-655-2942, Extension 14765.
H Oklahoma State
Oepartment of Health
From the Desks of Treta Whitethorn & Persenhone Starks
~poacy Pointers
Welcome Pam!!!
WIC Policy welcomed Pam McKenna onboard November 30, 2010! Pam will be working with the
PHOCISIWIC Helpdesk helping to resolve issues with:
• Unvoiding food instruments
• Issues with transfers
• Assistance with issuing WIC food instruments when it involves:
• Changing the client's status, category, certification date, termination date, and next FI date
• Issues with client records, why a clinic cannot input food packages, or issue Fls, why a clinic cannot
certify or reinstate a participant, and why dates did not change in PHOCIS
You can reach the PHOCISIWIC Helpdesk at (405) 271-4676 Ext. 50046 or 1(888) 655-2942 Ext. 50046
**********************************************************************************************************************
Verifying Proof of Residency
If a participant is receiving Medicaid and you have confirmed enrollment by visiting the
Eligibility Verification System, this site can also be used to confirm proof of residency.
PLEASE NOTE: You will not see the participant's address. You are confirming they are in the
Oklahoma Medicaid/SoonerCare Eligibility Verification System, and are therefore residents of Oklahoma.
If you are a WIC location that would like to have access to the Eligibility Verification System in order to
confirm enrollment and verify proof of residency, please contact Vickie Foster by phone at (405) 271-5585
Ext. 56521 or by email at VickiF@health.ok.gov.
**********************************************************************************************************************
Civil Rights and Security Awareness Trainings
Reminder: Civil Rights and Security Awareness Trainings are to be completed yearly. There is no date
affiliated with the completion of training. As long as the training is completed within a year
of the previous year's training, the requirement has been met.
Civil Rights and Security Awareness Trainings are available online and are accessible by visiting the WIC
Training Link at www.ok.gov/wic. Please be sure to print off a training log to sign and date at the completion
of each training ..
**********************************************************************************************************************
We enjoy answering your questions! Please feel free to email WIC policy related questions
to tretaw@health.ok.gov or persephone@health.ok.gov. The answer to your question may
be selected for publication in an upcoming issue of OkWIC Focus!
This is the section ofOklUC Focus where you can receive fun activities that reveal tips on hall' to continue to improve Oklahoma Wlt:'
and the services you provide each participant. We hope that you find this section helpful in the continued success of your WIC clinic. If
you have any questions regarding WIC Policy fee/Fee to call the policy line at (405) 271-5623 or toll free at J-888-0KLAWJC
(1-888-655-2942).
H Oklahoma State
Department of Health
---~
~ IF(Q)llilcyy mcill CCIlIDrilllcc®1lJRceJP)CO)Ictt
UJP)cill@ltce
By Josie Turner, ROlLO
WIC Program Consultant
American Academy of Pediatrics has recently released a new clinical report
"Diagnosis and Prevention of Iron-Deficiency and Iron-Deficiency Anemia in
Infants and Young Children (0-3 Years of Age)". This clinical report is a
revision of the AAP policy "Iron Fortification of Infant Formulas" from
July 1, 1999. The new report was created to help prevent iron deficiency anemia
in young children including infants who are both breastfeeding and formula fed.
Exclusively Breastfed Infant
The AAP states that full term exclusively breastfed infants have enough iron stores for at least the first four months
of life. Since human milk contains very little iron, it is recommended that exclusively breastfed term infants receive
iron supplementation of 1mg/kg per day starting at four months of age and continued until appropriate
iron-containing complementary foods have been introduced. Complementary foods may include iron-fortified
cereals for infants.
Formula-fed Infant
For formula-fed infants, iron needs for the first 12 months of life can be met by a standard infant formula and the
introduction of iron-containing complementary foods after 4 to 6 months of age, including iron-fortified cereals.
Please note that in some cases, supplements may be necessary if the iron needs are not being met by the intake of
formula and complementary foods.
For infants around six months of age consuming complementary foods, the report recommends at least 11 mg of
iron per day, ideally from iron-rich foods, and then supplementing with liquid iron as needed.
Preterm Infant
Preterm infants should have 2 mg/kg of iron per day for 12 months-an amount equivalent to that found in
iron-fortified formula. Preterm infants receiving only breast milk need this amount as a liquid supplement of 2mg/kg
until they begin eating complementary iron-rich solid foods or are weaned to iron-fortified formula.
Children
The report recommends toddlers 1-3 years of age should have an iron intake of 7mg/day. It is best to get this
amount of iron through eating red meats, cereals fortified with iron, and vegetables that contain iron. Fruits with
vitamin C can help with the absorption of iron. Liquid iron supplements may be given to toddlers from 12-36 months
of age. A chewable multivitamin is suitable for children older than three years.
Encourage mothers to discuss this recommendation with their health care provider in order to decide on appropriate
supplementation. Please refer to the online version of this article at:
http://aappolicy.aappublications. orq/cqilcontentlfull/pediatrics; 126/5/1040.
If there are any questions regarding the above policy changes please refer to the above web link or feel free to call
Josie Turner at 405-271-4676 ext. 50028.
H Oklahoma State
Department of Health
FROM THE CHIEF
Prevention of Obesity: A Vision for Infants
By Terry Bryce
Chief
Let's take a look at a global issue: Obesity. Let's also look at a global strategy: Breastfeeding!
There is no doubt some regions in the world are calling obesity an epidemic. Surgeon General Regina M. Benjamin
stated "today's epidemic of overweight and obesity threatens American's quality and years of healthy life" (The
Surgeon General's Vision for a Healthy and Fit Nation 2010). Until recently, most interventions have focused on
older children. Evidence continues to mount that breastfeeding is a component in the fight against obesity. The
breastfeeding preventative approach may be key in reversing obesity. But wait, if there is a connection, why are
there inconsistent results from studies examining the association between breastfeeding and subsequent obesity?
Unavoidably, various methodological limitations and issues affect this controversial connection.
While breastfeeding for any length of time has health benefits, exclusive breastfeeding appears to have a stronger
protective effect than breastfeeding combined with formula feeding. Additional research is needed to convince some
officials and policy makers that breastfeeding is protective against obesity. But for today, funding and time is limited.
Our vision is for greater breastfeeding duration and thus decreasing the risk of obesity.
Prevention of Obesity: A Vision for Infants
• Breastfeed exclusively for 6 months
• Feed age-appropriate nutritious foods in a responsive manner
• Allow infants to move, stretch, reach, crawl, run, play, and explore throughout their lives
• Allow infants to behave like babies
I am proud our breastfeeding rates are increasing. You are doing a great job and I hope to see even greater
improvement with the recent expansion and emphasis on the Peer Counselor Program. Let's continue to focus on
supporting breastfeeding in the workplace, educating mothers, and increasing professional education.
Thanks again for everything you do to promote and support breastfeeding for the health of Oklahomans!
(J((al ve tIie \f1U\ ate "
OSCJ)J{WIC Service
What's Up With WIC
Annual Oklahoma Nutrition/WIC Conference
What's Up with WIC
Breastfeeding Educator Course
IIth Annual Breastfeeding Symposium
What's Up with WIC
What's Up with WlC
January 7, 2011
February 2-4, 2011
April 8, 2011
April 20-22, 2011
June 3, 20] 1
July 8, 2011
October 14', 20 II
H Oklahoma Stat.
Oepartment of Health
By Priscilla Tiger, ROlLO
WIC Program Consultant
Two of the most common calls that the PHOCISIWIC Help Desk receives are regarding why the cert
date is so far in the future and why on the PHOCIS/Risk Assessment module a certain month will not
open up when the CPA is trying to assign a food package. These issues are somewhat related so I
thought I would use this PHOCIS Tips article to try and explain. This is primarily an issue on women
when they are coming back to the clinic to be recertified postpartum. Let me try to explain this issue to
give you some understanding into why this happens.
~e Mod!Jes Wle Modks Grouof>le't!bers verffic:&1ion Prlf'lters cer Status
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The CPA wants to give mom the fully breastfeeding package so what should she do? The CPA will need
to explain to the clerk that she wants to have the December Fls reissued for Jennifer. At this point the
clerk is reissuing Fl's from a previous certification and the December food package is entered off of the
Food Instrument Module and not off of Risk Assessment. The CPA still needs to assign the food package
number but the clerk is the one that will actually input the number into the food instrument module.
The actual procedure for issuing food instruments from a previous certification is explained in the Policy
and Procedure Manual, Section C-Food Instruments - Tips on Voiding and Reissuing Food Instruments/
Cash Value Benefits - H. Food instruments/cash value benefits that need a food package change,
and the food instruments are from a previous certification.
You will also notice on children that are being recertified that the certification date is usually not the visit
date. The new certification date is the previous termination date. The child's food instruments will start
on the certification date, not the visit date. For example, a child has a current certification period of
6-29-2010 through 12-29-2010. They come into the clinic on 12-15-10 to be recertified and have been
given food instruments through 12-29-10. The new certification period runs from 12-29-10 through
6-29-2011 and their food instruments begin on 12-29-2010.
I hope this information is helpful. Let me oryour WIC Program Consultant know if you have
additional questions about this information.
H Oklahoma State
Department of Health
Maximum Benefit
Card
By Cheryl Copeland, ROlLO
Relations and Information Specialist
The WIC Maximum Benefit card has been updated
and can now be ordered from shipping and
receiving! Federal Guidelines require that the
choice to achieve the full maximum allowance
must be made available to participants and that
local agencies must provide appropriate
education to participants about how to obtain their
full food package benefit. The Maximum Benefit
card was developed to make providing this
information easier. For more information on when •
to provide the Maximum Benefit card to :• participants, please refer to policy Section A. :
Certification: WIC :
Records and :•
Documentation. :
Please specify ODH :•
868P when :
ordering, and :
• remember to give ••
this valuable tool to :
your participants with: • their WIC Approved :
Food Card so that
, they can receive the
most benefit from
their WIC Food
Instruments!
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••:
COlltl-actOl-'S Corller ••••
• By Richard Woofter Sub-Recipient Contracts Specialist
February is quickly approaching. Again this year, the
Independent Contractor's Meeting is being held in
conjunction with the Statewide WIC Conference. The
date for the Independent Contractors Meeting has been
set for Wednesday, February 2nd and is scheduled from
9am to 11am. Both conferences will be held at the
Embassy Suites in Norman.
In previous years, attendance at the Independent
Contractor's Meeting has been optional; however, that is
not the case this year. Due to language in the
Independent Contract, the contractor's financial officer,
director, or WIC director must attend a mandatory post
award contractor's conference. This is your chance to
meet that contractual requirement.
There will be several items of discussion including review
of the most recently completed and negotiated
contract. As everyone is aware, this is a one-year
contract with four one year renewal periods. Staff from
both WIC Service and other Oklahoma State Department
of Health divisions will be available to answer questions
pertaining to the contract or other areas of concern.
The agenda for the Statewide WIC Conference looks
especially dazzling this year. The lineup of exciting
speakers includes Oklahoma City's own mayor, Mick
Cornett. Hopefully everyone attending the Independent
Contractor's Meeting can make plans to stay for all three
days of the State WIC Conference. Details, as well as the
agenda, can be found on the WIC training link.
Remember, January 15, 2011 is the last date for
registration.
If you have items you would like included on the
Independent Clinic Meeting agenda, please send them to
me at richardw@health.ok.gov. If you have
questions or concerns you can also email those to me, or
call 405-271-4676, Extension 50033. The toll free
number is 1-888-655-2942, Extension 50033.
•••••••
H Oklahoma State
Department of Health
Dear Aunt Norma,
We just had a mom come to our
WIC clinic who insists on buying
Enfamil Premium for her son,
but she wants WIC baby fruits
and vegetables when he turns
six months. What kind of food
package, if any, can I give to him?
Some staff members tell me if we
don't give him formula, we can't
give him anything. He's not a
breastfed baby so I don't feel right
about giving him a breastfeeding
package with higher baby food
amounts. I really don't think it
is right to give a package for a
formula I know isn't going to be
used by this family. What can I
do?
Package Perplexed
Dear Perplexed,
Thank you for asking this timely
question and for wanting to do
whatever you can to help this
family. I am sure you have
already worked with this family
to accept Good Start formula
but that does not sound like it's
an option for them right now.
There is an answer for this
little guy, however. Issue him a
BUY package. What's a BUY
package, you ask? It's a set of
food packages designed just for
this situation. When the caregiver
wants to buy the infant's formula
themselves, FOBUYcan be
entered for the first six months
followed by F6BY1
(for four months) and F6BY2
(for two months)*. These food
packages will generate food
instruments with the phrase, "This
food instrument has no cash
value" on the first food instrument.
Think of this as a placeholder in
case they come back willing to
try Good Start formulas again,
then that food instrument could
be voided and reissued for
formula. The second and third
food instruments have the same
amount of baby foods as the other
fully formula fed infants. Once
you have selected this package
be sure and tell the parents that
as their baby matures, he may
be able to accept Good Start
formula again. They are then
more than welcome to come back
and receive our contract formula.
Thanks for this wonderful
question and hopefully you can
share with your coworkers so no
one is 'perplexed'. Bye for now!
ofWlt c/fo'Una
*Also available:
• Partially BF Infants, age 1-5
months:
o P1BUY
• Partially BF Infants, age 6-11
months:
o P6BY1 (use for 4 months)
and P6BY2
(use for 2 months)
• Occasionally BF Infants, age 1-5
months:
o Y1BUY
• Occasionally BF Infants, age
6-11 months:
o Y6BY1 (use for 4 months)
and Y6BY2
(use for 2 months)
H Oklahoma State
Department of Health
For going ABOVE and BEYOND, WIC Service would
like to bestow high fives on: Rhodena OeWitt ROlLO,
Carrie Emberton ROlLO, Shannon Kennedy MS,
ROlLO and Stacy Walker MA,RO/LO. These nutrition therapists were an integral part of the
continuation of the Individual Nutrition Education pilot project from August 1, 2010-
October 1, 2010. Giving generously of their time, sharing suggestions and keen
observations, they improved the Eating Behavior Assessment Tool for participants and
staff. We would like to thank them for their willingness to pilot this tool and being
instrumental in assisting WIC develop effective nutrition education materials.
If you would like your clinic or someone at your clinic
to be recognized for an outstanding accomplishment,
please email your story to mandyc@health.ok.gov.
Rhodena Dewitt Carrie Emberton
Shannon Kennedy Stacy Walker
H Oklahoma State
Department of Health
w By Christina Windrix, ROlLO
WIC Program Consultant
UPDATE ON INDIVIDUAL NUTRITION
EDUCATION POLICY
The Individual Nutrition Education Policy was revealed at our Annual Oklahoma Nutrition/WIC Conference
in 2010. We are excited to announce that we have completed the final phase in our pilot! The policy will
now go through a few final steps before it is available to ALL our WIC nutritionists for use.
To quickly recap, the new Individual Nutrition Education Policy will allow the high-risk WIC participant to
have access to the expertise and skill of our nutritionists by receiving an Individualized Nutrition Care Plan,
which is required by USDA/FNS. A Nutrition Care Plan will be developed and documented based on the
complete nutrition assessment and planned nutrition counseling and strategies. Tools were developed to
explore the participant's eating behavior and environment. They are available for each participant category
and are titled Eating Behavior Assessment Tools (EBAT). As we all know, the eating environment
influences our nutrition decisions and choices. It has a major impact on nutritional/health status and sets
the stage for a lifetime of eating habits. Guidance sheets have also been developed to assist the local
agency nutritionist understand the objective(s) of each question from the EBAT. The nutrition assessment
includes information obtained through anthropometric measurements, dietary history, nutrition/health goal
set at certification/recertification, and evaluation of the EBAT.
Our pilot took place in both Independent and County Health Departments with six nutritionists assisting in
the pilot, Rhodena DeWitt, Carrie Emberton, Shannon Kennedy, Brenda Sanchez, Lindsay Upchurch, and
Stacy Walker. They provided insightful advice and important feedback to help with the organization of the
EBAT. They reported that the EBAT was helpful for all categories. It provided structure to the Individual
Nutrition Education Appointments and formed a base for nutrition education counseling. After becoming
familiar with the tools, they reported there was enough time to complete all required components of the
individual appointment. Many reported that it made their WIC Encounter documentation easier, especially
if they could not document immediately following the appointment. The tool helped establish a relationship
between the nutritionist and participant. It also helped in forming an open relationship where dialogue can
occur. All of the nutritionists involved in the pilot project reported that they found the tools to be beneficial
in the individual appointment.
As previously mentioned, we are in the final phase of the Individual Nutrition Education Policy. Once this
policy is available, your WIC Program Consultant will contact the local agency nutritionist for further
training.
H Oklahoma State
Oepartment of Health
WIC Matters
Using the New Prenatal Weight
By Cathy Montgomery, MS, ROlLO
WIC Program Consultant
A laminated prenatal weight gain grid has recently been provided to every CPA. Although we no longer
require filing a copy of the prenatal weight gain in the participant record, it is still very important to plot the
pregnant woman's weight. One of the nutrition education protocols for prenatal women is to discuss the
recommended weight gain and rate of gain needed to promote healthy birth outcomes.
The laminated grid is a tool that allows the pregnant woman to see how her weight is progressing and
encourages questions. Plotting the woman's weight on the grid also helps the CPA assess her weight gain
status. Risks 131 and 133 can only be assigned if the weight gain is correctly plotted. Risk 132
(Wt. Loss Current Preg.) is another applicable risk that may e assigned when a pregnant woman is
experiencing low maternal weight gain issues
The new prenatal weight gain grids now have 4 i er nt BMI ranges: Underweight, Normal Weight,
Overweight, and Obese. Here are the steps to follow to correctly use the prenatal weight gain.
Complete the PHOCIS/WIC Health History Module for the pregnant woman. A BMI value will
be assigned based on the height and weight entered.
Using the new Prenatal Weight Gain Grid, find the category that includes the BMI value collected.
o If the BMI is <18.5, use the Underweight recommendations. The Underweight weight
gain range on the graph is a series of blue dots (. ).
o If the BMI is 18.5-24.9, use the Normal weight recommendations. The Normal
weight gain range on the graph is a solid black line ( ).
o If the BMI is 25.0-29.9, use the Overweight recommendations. The Overweight
weight gain range on the graph is a series of green dots and lines L._._._}.
o If the BMI is> or = 30.0, use the Obese recommendations. The Obese weight gain
range on the graph is a series of red lines L ).
H Oklahoma State
Oepartment of Health
WIC Matte rs.;
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